alcohol use and abuse (lecture) Flashcards
How many deaths are related to alcohol abuse each year ?
3 million worldwide
Where does alcohol abuse rank in the leading causes of death ?
7th leading cause of death
Which age range is most likely to present with alcohol dependence/harm ?
35 - 54
How does alcohol interact with sleep?
decreases the quality of sleep by interrupting the sleep cycle
What is dipsomania?
alcoholism characterised by intermittent cravings for alcohol
What is Potomania ?
electrolyte disturbance brought bout by the dilution effect of drinking lots of beer
What are the ICD-11 criteria for diagnosing alcohol dependence
- disordered regulation/control of alcohol use
- repeated/continuous use of alcohol
- strong internal drive to use alcohol
- prioritisation of alcohol over other activities
- persistent use despite harms
- present for 12 months (or 1 month if very serious/continuous)
= chronically relapsing disorder
Which neurotransmitter system is down regulated by alcohol ?
GABA-A
Which neurotransmitter system is up regulated by alcohol ?
Glutamate
What is involved in the CAGE alcohol questionnaire ?
C - has patient ever felt a need to cut down on their drinking ?
A - have people annoyed them by criticising their habits ?
G - have they ever felt guilty about drinking ?
E - has patient used alcohol as an eye-opener = first thing in the morning to steady nerves/reduce hangover etc
Is the CAGE questionnaire seen as an effective method of assessing alcohol dependance ?
Not really, better than nothing but the ICD-11 criteria and WHO AUDIT are better methods
Which tool is considered the gold standard method of diagnosing alcohol dependence ?
WHO AUDIT
(FAST version in a&e)
What is the UK guidance for ‘safe drinking’ ?
14 units per week, spread over 3 days at least
What does an ABV of 12% mean in terms of how much alcohol is in that bottle?
12% ABV = 12% of the bottle is alcohol
How much pure alcohol (ml and g) is in 1 unit ?
10ml = 8g
What is a quick way to estimate units ?
ABV in 1000ml = units
e.g…
1000mls of 5% beer = 5 units
500mls of 10% wine = 5 units
What effect does frequent binge drinking at 18-25yrs old have on future risk of alcohol dependence ?
2-3x higher risk
How many calories are there in 1g of pure alcohol ?
7.1 calories
(almost double that of 1g of carbs)
What does the ‘J shaped curve’ in alcohol study show about alcohol and mortality ?
- some alcohol is protective against mortality
- on the whole, the more drinks per day = higher mortality risk
this study has been debunked now
What are some effects of alcohol on the oesophagus ?
- increased cancer risk (esp. squamous cell carcinoma)
- oesophageal varices (enlarged veins) associated with liver disease
How might oesophageal varices present ?
- drop in Hb due to varices bleeding
- raised urea
- coffee-ground vomit
What are some effects of alcohol on the stomach ?
- acute gastritis
- acute ulceration
- chronic peptic ulceration
- portal gastropathy
What are the mechanisms of alcohol related liver disease ?
- direct toxic effects
- indirect metabolite effect
- causes activation of free radicals
- causes induction of enzyme systems
- causes nutritional deficiencies (B12, thiamine)
- causes liver function impairment
What are the effects of alcohol on the pancreas ?
- acute pancreatitis
- chronic pancreatitis
How does acute pancreatitis present ?
- severe abdominal pain
- radiating to back
- nausea/vomiting
- greatly elevated serum amylase
How does chronic pancreatitis present ?
- intermittent severe upper abdominal and back pain
- weight loss
- exocrine tissue replaced by fibrosis
- leads of pancreatic malabsorption (steatorrhoea, reduced vitamins)
- relative preservation of endocrine tissue
What % of heavy drinkers progress to alcoholic hepatitis or cirrhosis ?
10-20 %
By how much does >9 units/day increase a womans risk of alcohol liver disease ?
> 9 units/day = 12x increased risk in women
By how much does >9 units/day increase a mans risk of alcohol liver disease ?
> 9 units/day = 4x increased risk in men
Are men or women at greater risk of alcohol liver disease ?
women are at higher risk, even at lower amounts of alcohol
What does obesity do to the risk of developing alcohol liver disease ?
obesity doubles the risk
What is the progression of alcoholic liver disease ?
- acute fatty change reversible
- hepatic fibrosis reversible
- cirrhosis irreversible
- hepatic decompression fatal
acute hepatitis can occur along the way
What are some physical presentations of liver failure ?
- jaundice
- ascites (very round belly)
What are some effects of alcohol on the heart ?
- atrial fibrillation
- MI (heart attack)
- congestive heart failure (cardiomyopathy)
What are some neuropsychiatric disorders associated with alcohol dependance ?
- seizures in withdrawal (10% mortality)
- delirium tremens = delirium/hallucinations in withdrawal
- wernicke’s encephalopathy = acute delirium, ataxia, ophthalmoplegia
- korsakoff’s psychosis = chronic tried of short term memory loss, confabulation, ataxia (secondary to thiamine deficiency)
- polyneuropathy (secondary to B12/thiamine deficiency)
How does delirium tremens present ?
delirium with hallucinations and autonomic disturbances in alcohol withdrawal
confusion, paranoia etc
How does Wernicke’s encephalopathy present ?
acute:
- delirium
- ataxia
- ophthalmoplegia
How does Korsakoff’s psychosis present ?
chronic triad of:
- short term memory loss
- confabulation
- ataxia
doesn’t have to be all 3
When is the peak incidence of siezures within a withdrawal period ?
1-2 days after cessation of drinking
Does delirium tremens present early or late in the withdrawal period from alcohol ?
later
How does the severity of withdrawal symptoms change with each relapse ?
withdrawal symptoms get worse with each withdrawal period
What effect does regular drinking have on GABA-A receptor function?
the body down regulates GABA-A receptors, because alcohol is a GABA-A agonist so the body thinks there’s plenty of it
What effect does regular drinking have on NMDA receptor function?
the body up regulates NMDA receptors because alcohol is an NMDA (glutamate) antagonist
What is the mechanism of alcohol inducing seizures ?
The imbalance between GABA-A and glutamate, befuase alcohol…
- down regulates GABA-A receptors
- up regulates NMDA receptors
What drugs can be used to reduce chances of alcohol induced seizures ?
benzodiazepines (for GABA-A system)
- chlordiazepoxide
- diazepam
Thiamine (for NMDA system)
What is in the drug Pabrinex ?
thiamine
Which drug is used in alcohol relapse prevention ?
Acamprosate
What is myopathy ?
weakness and dysfunction in skeletal muscle
Which muscles are most affected by myopathy as a result of alcohol dependence ?
proximal muscles in pelvic girdle
What is the physiology of thrombocytopenia as a result of alcohol dependence ?
- alcohol is toxic in bone marrow = leads to reduced normal cell levels
- effects on the liver leads to folate deficiency which affects blood cells
What is thrombocytopenia?
platelet deficiency
What is pancytopenia ?
deficiency of all major cells in blood
white, red, platelets
Describe the process of alcohol metabolism …
-
Ethanol —> acetaldehyde
via
- alcohol dehydrogenase
- catalase
- P4502E1(microsomes) -
Acetaldehyde —> acetate
via aldehyde dehydrogenase
Which step of alcohol metabolism does the drug Disulfiram inhibit ?
acetaldehyde —> acetate
Which enzyme does the drug Disulfiram inhibit ?
aldehyde dehydrogenase
What is the reaction like if a person drinks while on disulfiram ?
Bad reaction
- nausea
- tachycardia
- palpitations
What is the idea behind prescribing disulfiram to stop alcohol dependence ?
the drug interacts with alcohol metabolism in a bad way so the effects are so unpleasant that people will stop drinking on their own accord
What are some non-medication methods of reducing alcohol dependence ?
- patient makes a drink diary
- consider behaviour changes
- assess trigger points
- swap to a lower strength alcohol
- don’t go cold turkey - drink at a lower level to prevent withdrawal symptoms
- refer to drug/drink services
